| NPI | 1811441850 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WA PH 60626956) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: IA 22253) |
| 183500000X Pharmacist (Licence: MN 122151) | |
| Enumeration Date | 2016-08-08 |
| Last Update Date | 2017-01-23 |